Changes in intraocular pressure after pharmacological pupil dilatation in an elderly Chinese population in Taiwan: The Shihpai eye study.

BACKGROUND: Mydriatic drugs are often used in ophthalmic clinics for pupil dilatation to assess the optic nerve and retina. Clinical studies have indicated that an increase in intraocular pressure (IOP) after pupil dilation is noted in open-angle glaucoma patients, those with narrow angles and in normal subjects. Asians are more likely to have narrow angles. Moreover, age-related cataract may increase the crowdedness of the angle. This study aimed to assess the effects of mydriatic pupil dilatation on IOP in an elderly Chinese population. METHODS: The Shihpai Eye Study was a community-based, cross-sectional survey of vision and eye diseases among noninstitutionalized subjects aged 65 years and older in Shihpai, Taipei, Taiwan. IOP was taken using noncontact tonometry. The pupil was dilated with 1% tropicamide. IOP was measured again after maximal pupil dilatation 1 hour after mydriasis. RESULTS: Of the 2045 participants, 1361 (66.6%) participated in both the questionnaire and eye examinations. The mean IOP before pupil dilatation was 12.9 ± 3.1 mmHg and was 12.8 ± 3.4 mmHg (range: 5-36 mmHg) after pupil dilatation. IOP higher than 21 mmHg after pupil dilation was noted in 17 (1.34%) participants, of whom IOP exceeded 30 mmHg in two (0.16%). Overall, the changes in IOP before and after pupil dilatation were insignificant ( p = 0.04). In the final regression analyses, refractive status toward hyperopia ( p < 0.01) was the only significant factor associated with an increase in IOP of at least 4 mmHg after pupil dilatation. CONCLUSION: Our results revealed that the increase in IOP after pharmacological pupil dilatation was minimal, and the incidence of acute angle-closure attack was insignificant. Hyperopic status was the only factor related to an increase in IOP of > 4 mmHg. Caution should be exercised if one is hyperopic or has a history of glaucoma and rechecking IOP in these subjects is suggested after pharmacological mydriasis.

Association between dry eye and depressive symptoms in an elderly Chinese population in Taiwan: the Shihpai Eye Study.

BACKGROUND: Dry eye may impact quality of life and daily activities and depression is a widespread illness. Many studies showed the two diseases often coexist. However, studies were limited to retrospective chart review. This study aimed to investigate the association between dry eye and depressive symptoms in an older Asian population. METHODS: The Shihpai Eye Study was a community-based, cross-sectional survey of vision and eye diseases among noninstitutionalized subjects 65 years of age and older in Shihpai, Taipei, Taiwan. Residents fulfilling these criteria were randomly selected to be invited to participate in the study, which included a questionnaire and an eye examination conducted between July 1, 1999 and December 31, 2000. RESULTS: Of the 2045 subjects recruited, 1361 (66.6%) completed the examination. 8.8% (95% confidence interval (CI): 7.3-10.3%) of the participants were diagnosed to have depressive symptoms. Under multivariate analysis, depressive symptoms were significantly associated with frequent symptoms of dry eye (odds ratio (OR): 1.97, 95% CI: 1.36-2.92; p < 0.001). None of the dry eye signs was associated with depressive symptoms. For participants reporting frequent symptoms, tear-film break-up time ≤ 10 s (OR: 2.06, 95% CI: 1.38-3.05; p < 0.001), Schirmer test score ≤ 5 mm (OR: 2.01, 95% CI: 1.33-3.03; p < 0.001), and meibomian gland disease (OR: 1.99, 95% CI: 1.31-3.01; p = 0.001) were significantly related to depressive symptoms. Fluorescein staining of the cornea was not correlated to depressive symptoms in participants with dry eye symptoms. CONCLUSIONS: Depressive symptoms are more highly correlated with dry eye symptoms than dry eye signs.

Changes in refractive status in an elderly Chinese population in a 7-year follow-up: The Shihpai Eye Study.

BACKGROUND: Refractive error is the major cause of moderate and severe visual impairment. Visual impairment limits people's ability to perform daily tasks and affects their quality of life. Longitudinal data on the refractive status of the elderly was available only for whites and Africans. The purpose of this study was to report the 7-year incidence of myopia, hyperopia and refractive error change as well as their associated risk factors in a metropolitan elderly Chinese population. METHODS: The Shihpai Eye Study 2006 included 460/824 (55.8%) subjects (age range 72-94 years old) of 1361 participants in the 1999 baseline survey for a follow-up eye examination. Incidences were calculated for those who had emmetropia (-0.50D < spherical equivalent (SE) <+0.50D) at baseline. Refractive error change at 7 year was defined as (SE at the 7-year visit - SE at baseline). RESULTS: 90 (26.4%) subjects were emmetropic, 61 (17.9%) were myopic and 190 (55.7%) hyperopic. The mean refractive error was 0.49 ± 2.19 D and the average change in refractive error was -0.13 ± 1.03 D. The incidence of myopia at seven-year was 26.8 % [95% Confidence interval (C.I.): 22.8%-30.9%] and the incidence of hyperopia was 19.7% (95% C.I.: 16.1%-23.3%). Nuclear sclerosis (>Grade 2 vs. ≤Grade 2) [p < 0.0001; relative risk (RR): 8.94; 95% C.I.: 4.40-18.2], anterior chamber depth (mm) [p = 0.05; RR: 0.43; 95% C.I.: 0.18-1.01] and lens thickness (mm) [p < 0.01; RR: 2.35; 95% C.I.: 1.17-2.73] were significantly associated with myopic shift. On the other hand, hyperopic shift was significantly associated with cortical opacity (>Grade 2 vs. ≤Grade 2) (p = 0.02; RR: 1.21; 95% C.I.: 1.02-3.54). CONCLUSION: In this elderly Asian population, there was on average a slight myopic shift. The incidence of myopia was comparable to population-based studies of other ethnic groups, whereas the incidence of hyperopia was substantially higher.

The association of visual impairment and 3-year mortality among the elderly in Taiwan: the Shihpai Eye Study.

BACKGROUND: The association between visual impairment and mortality has been controversial. Moreover, literature on the relationship was very limited in the Asian population. The purpose of this study was to investigate whether visual impairment increases the 3-year risk of mortality in a cohort of urban Chinese elderly individuals. METHODS: Participants in the Shihpai Eye Study, who were aged ≥65 years, with a baseline examination conducted between July 1, 1999 and December 31, 2000, were recruited for the current study. The total number of possible participants identified was 4750. Of those, 3746 persons were eligible, and 2045 persons were randomly selected to be invited to participate in the study. Of those 2045 individuals, 1361 (66.6%) participated in both the questionnaire and eye examination. A follow-up of a fixed cohort was also conducted after 3 years. The death of any participants was confirmed through the household registration system. RESULTS: Of the 1361 participants included at baseline, 54 (3.97%) died before the 3-year follow-up. Multiple logistic regression analysis showed that mortality was significantly associated with a fall history [relative risk (RR): 2.12; 95% confidence intervals (CI): 1.08-3.98] and a history of diabetes (RR: 2.06; 95% CI: 1.03-3.95). Visual impairment was not a significant predictor of mortality after adjustment for confounders. CONCLUSION: After adjustments were made for age, sex, education, marital status, lifestyle factors, depression symptoms, fall history, and history of systemic diseases, visual impairment was not a significant predictor of 3-year mortality in elderly persons.

Efficacy of intravitreal injection of anti-vascular endothelial growth factor agents for stage 4 retinopathy of prematurity.

PURPOSE: To investigate the efficacy of intravitreal injection of anti-vascular endothelial growth factor agents for Stage 4 retinopathy of prematurity. METHODS: Retrospective case series study. The medical records of patients receiving intravitreal injection of anti-vascular endothelial growth factor agents for Stage 4 retinopathy of prematurity from January 2007 to May 2012 in Taipei Veterans General Hospital were reviewed. RESULTS: A total of 13 eyes of 7 patients (3 boys and 4 girls) with Stage 4 retinopathy of prematurity were included. The mean gestational age and birth weight were 27.6 ± 2.6 weeks (range, 24.5-30.5 weeks) and 893.1 ± 293.2 g (range, 550-1422 g), respectively. The mean age at the time of injection was 38.2 ± 1.9 weeks (range, 36.0-41.5 weeks) postmenstrual age, and the mean follow-up period was 37.8 ± 19.5 months (range, 11.0-67.5 months). The active neovascularization regressed rapidly, and the anatomical outcomes were favorable in all patients. One eye developed recurrent retinal hemorrhage with localized retinal detachment 21 weeks after initial treatment, which resolved after a second injection. There were no ocular or systemic complications in these patients. CONCLUSION: Intravitreal injection of anti-vascular endothelial growth factor agents may be effective as monotherapy or as supplement to failed laser treatment for patients with Stage 4 retinopathy of prematurity without additional surgical intervention. Further randomized controlled trials are necessary to compare the clinical efficacy and safety with other conventional interventions.

Hyperhomocysteinemia in patients with polypoidal choroidal vasculopathy: a case control study.

PURPOSE: To determine whether elevated plasma homocysteine and serum high sensitivity C-reactive protein (hsCRP) levels, two established risk factors of vascular diseases, are associated with polypoidal choroidal vasculopathy (PCV). DESIGN: Retrospective case-control study. METHODS: One hundred and nineteen consecutive patients with PCV and 119 matched controls were enrolled in a tertiary hospital from September 2008 to June 2013. Plasma homocysteine and serum hsCRP levels were measured. Associations among plasma homocysteine, serum hsCRP levels and PCV were further evaluated using multivariable logistic regression analysis. RESULTS: The median plasma homocysteine level was significantly higher in patients with PCV than in the controls (12.20 µmol/L vs. 9.80 µmol/L, p<0.001). The median serum hsCRP level was slightly higher in the PCV group (0.16 mg/dl vs. 0.11 mg/dl in control group, p = 0.07). After multivariable logistic regression analysis, each 1 µmol/L increase of plasma homocysteine was associated with a 1.5-fold increase in likelihood of having PCV (OR, 1.54; 95% confidence interval (CI), 1.33-1.79, p<0.001). CONCLUSIONS: Hyperhomocysteinemia was associated with PCV and might play a role in the pathogenesis of PCV.

Intraocular involvement of T-cell lymphoma presenting as inflammatory glaucoma, neurotrophic keratopathy, and choroidal detachment.

Intraocular involvement of T-cell lymphoma is rare. We report a case presented with inflammatory glaucoma, neurotrophic keratopathy, and choroidal detachment. An 81-year-old man presented with unilateral high intraocular pressure and keratic precipitates. Polymerase chain reaction of the aqueous humor was negative for herpes simplex virus type 1 and 2, varicella zoster virus, and cytomegalovirus. Progressive pupil dilatation, cornea anesthesia with large epithelial defect, and choroidal detachment were noted in the following month. Diagnostic vitrectomy was then performed, and cytology of the vitreous suggested malignant lymphoma. Further systemic workup revealed ulcerative lesions in the stomach, and biopsy with special stains led to the diagnosis of peripheral T-cell lymphoma of the stomach with ocular involvement. Intraocular involvement of T-cell lymphoma is very rare. Most typically, the skin, followed by the central nervous system, has the most frequently occurring concurrent systemic involvement. In fact, stomach involvement has not been reported. Most cases of intraocular lymphomas presented with vitritis and anterior uveitis, and elevated intraocular pressure was not commonly observed. A review of the literature indicates that a large corneal epithelium defect has been described only in a case of peripheral T-cell lymphoma with the involvement of sclera and oropharynx. Although very rare, inflammatory glaucoma, neurotrophic keratopathy, and choroidal detachment can be the initial presentation of intraocular involvement of T-cell lymphoma.

Distribution and associated factors of optic disc diameter and cup-to-disc ratio in an elderly Chinese population.

BACKGROUND: Glaucoma is the second leading cause of blindness worldwide and East Asian people account for almost half of those affected. Vertical elongation of the optic cup is a characteristic feature of glaucoma. However, there is a significant overlap in the vertical cup-to-disc ratio (VCDR) between normal eyes and eyes affected by glaucoma. The purpose of this study was to determine the distribution of VCDR and vertical disc diameter (VDD) and their predictive factors in a population of elderly Chinese residents in Taiwan. METHODS: Four hundred and sixty elderly Chinese residents aged 72 years and older in the Shihpai district, Taipei, Taiwan participated in this study. Slit lamp biomicroscopic measurement of the VCDR and VDD after pupil dilation with a 78 diopter lens was performed by one glaucoma specialist. Multiple linear regression analyses were used to fit the best model for independent variables. RESULTS: The VCDR was recorded for 438 right eyes and 430 left eyes. After excluding participants with glaucoma, the mean ± SD VCDR was 0.44 ± 0.17 for both eyes, and the 97.5(th) percentile was 0.8. A greater VCDR was associated with a longer axial length [VCDR = -0.47 + 0.04(axial length)] under multiple regression analysis. The VDD was obtained for 420 right eyes and 406 left eyes. The mean ± SD VDD for all participants was 1.77 ± 0.22 mm for the right eye and 1.79 ± 0.22 mm for the left eye. A higher body mass index (BMI) and a longer axial length were significantly associated with a larger VDD under multiple regression analysis. [VDD = -0.05 + 0.07 (axial length) + 0.06 (obesity); if BMI <24, then obesity = 0; if BMI ≥ 24, then obesity = 1]. A larger VDD was associated with a larger VCDR (p < 0.001) and the VCDR could be predicted by the equation VCDR = -0.07 + 0.3VDD. CONCLUSION: A greater VCDR was related to a longer axial length. A greater VDD was related to a higher BMI and a longer axial length.

Persistent exudative retinal detachment after photodynamic therapy and intravitreal bevacizumab injection for multiple retinal capillary hemangiomas in a patient with von Hippel-Lindau disease.

Photodynamic therapy (PDT) has been used in treating peripheral retinal capillary hemangioma (RCH) with satisfactory results. We report a rare case of von Hippel-Lindau (VHL) disease with three large peripheral RCHs, treated with PDT and intravitreal bevacizumab injection (IVB), who developed persistent bullous exudative retinal detachment (RD) despite significant tumor regression. The patient is a sporadic case of VHL disease, with a de novo nonsense mutation in codon 161 with C → T transition at nucleotide position 694 of the VHL gene. Multiple RCHs were noted in both eyes. Four small RCHs were found in the left eye and were treated with laser photocoagulation. Three large RCHs in the peripheral retina of the right eye were complicated with cystoid macular edema and subretinal fluid accumulation. The RCHs were treated with PDT combined with IVB, and bullous exudative RD developed on the second day after treatment. Three months after PDT, the tumors had regressed significantly, but exudative RD persisted, despite multiple IVB and intravitreal triamcinolone acetonide injection (IVTA). External drainage with sclera buckling, IVB, and IVTA were performed, and the retina attached after surgical intervention. The application of PDT in the treatment of RCHs and its possible complications are discussed.

Seven-year incidence of age-related cataracts among an elderly Chinese population in Shihpai, Taiwan: The Shihpai Eye Study.

PURPOSE: To report the 7-year incidence of age-related cataracts in a metropolitan Chinese elderly population. METHODS: The Shihpai Eye Study 2006 included 460 (55.8%) of 1361 participants in the 1999 baseline survey for a follow-up eye examination. Cataract was graded by one ophthalmologist using the Lens Opacities Classification System III. RESULTS: The 7-year incidence of pure nuclear opacity was 18.5% (95% confidence interval [CI]: 12.7%-24.3%)]; 34.7% (95% CI: 27.6%-41.8%) for cortical opacity; and 0.6% (95% CI: 0%-1.8%) for posterior subcapsular opacity. On the other hand, 11.6% (95% CI: 6.8%-16.4%) participants developed both nuclear and cortical opacity, 3.5% (95% CI: 0.8%-6.2%) nuclear and posterior subcapsular opacity; and 1.7% (95% CI: 0%-3.6%) cortical and posterior subcapsular opacity. A total of 3.5% (95% CI: 0.8%-6.2%) of participants developed all three types of cataract. Nuclear cataract was significantly associated with current smoking (P = 0.04; relative risk [RR]: 2.05; 95% CI: 1.05-3.99). Males were almost half as likely (P = 0.04; RR: 0.57; 95% CI: 0.34-0.97) to develop cortical opacity, whereas participants with a history of diabetes were approximately twice as likely to develop cortical opacity (P = 0.05; RR 2.43; 95% CI: 1.02-5.81). A higher level of education (P = 0.03; RR: 0.40; 95% CI: 0.18-0.91) and a higher body mass index (P = 0.02; RR: 0.28; 95% CI: 0.10-0.79) was protective of posterior subcapsular cataract. CONCLUSIONS: This study indicated a high incidence of cortical opacities and lower incidence of nuclear opacities compared with Caucasians. Posterior subcapsular opacity incidence and cataract surgery rate were comparable.

Short-term external buckling with pneumatic retinopexy for retinal detachment with inferior retinal breaks.

PURPOSE: To introduce a new approach for short-term external scleral buckling with pneumatic retinopexy for the management of rhegmatogenous retinal detachment with inferior retinal breaks. DESIGN: Retrospective, noncomparative, interventional case series. METHODS: A review of 33 consecutive eyes of 31 patients who underwent external buckling with pneumatic retinopexy for uncomplicated rhegmatogenous retinal detachment with inferior retinal breaks from December 2006 through December 2010. An external buckle was made of a 505 sponge sutured along the blunt side of a 279 tyre (MIRA Inc). The buckle was inserted deeply into the inferior fornix without suture after pneumatic retinopexy and was kept in place for 3 days. Primary and final anatomic outcomes, visual acuity, and adverse events were recorded. RESULTS: All patients tolerated the procedure. The mean follow-up period was 24.0 months (range, 9 to 61 months). Primary success, defined as successful retinal reattachment within 6 months without further treatment, was achieved in 29 (87.9%) eyes. All patients attained final retinal reattachment (100%). Overall, the mean best-corrected visual acuity improved significantly at the end of follow-up (0.30 logarithm of the minimal angle of resolution units; Snellen equivalent, 6/12), compared with the preoperative best-corrected visual acuity (0.82 logarithm of the minimal angle of resolution units; Snellen equivalent, 6/38; P < .001). CONCLUSIONS: Short-term external buckling with pneumatic retinopexy is a novel and effective treatment for rhegmatogenous retinal detachment with inferior retinal breaks, with a comparable success rate with other treatment methods. This approach also can avoid complications of long-term buckle implantation. Further comparative cohort studies may be necessary to compare the clinical efficacy with other conventional operations.

Optical coherence tomography in resolution of photoreceptor damage in multiple evanescent white dot syndrome.

Multiple evanescent white dot syndrome (MEWDS) is an acute-onset chorioretinal inflammatory disease. This disorder is characterized by unilateral multiple gray-white dots of the posterior pole in young healthy women. Symptoms include blurred vision, photopsia, and visual field (VF) defects. Although the etiology of MEWDS is still unknown, most patients have spontaneous improvement in vision and fundus appearance within a period of weeks. Herein, we report a typical case of MEWDS, and describe the spontaneous resolution of photoreceptor damage during the entire course, demonstrated by serial optical coherence tomography (OCT). The OCT is a sensitive and noninvasive tool for the diagnosis and serial microstructure evaluation of patients with MEWDS.

Treatment of microsporidial keratoconjunctivitis with repeated corneal swabbing.

PURPOSE: To report the effect of repeated corneal swabbing in patients with microsporidial keratoconjunctivitis. DESIGN: Retrospective noncomparative case series. METHODS: Sixteen eyes of 14 healthy patients with microsporidial keratoconjunctivitis were diagnosed based on the detection of microsporidia in corneal scrapings using Gram stain, the modified Kinyoun acid-fast stain, or both. Polymerase chain reaction plus gene analysis of the microsporidian 16S ribosomal RNA had been performed in 10 patients who sought treatment between 2010 and 2011. Some of the lesions were scraped for procurement of specimens. The remaining lesions were wiped off gently by cotton swabs. Repeated swabbing was performed if infection persisted or new lesions were observed at follow-up. To prevent secondary bacterial infection, 0.3% norfloxacin or 0.25 % chloramphenicol were prescribed. RESULTS: The mean age was 52.2 years. All patients had the characteristic disseminated, punctate, slightly elevated, white epithelial lesions. The denser white lesions could be removed easily after gentle swabbing, and most epithelium remained intact. The 10 cases with positive polymerase chain reaction results were all identified to be Vittaforma corneae. The mean number of corneal swabbing was 3.3, and the mean disease resolution time was 6.6 days. No patients had recurrence or loss of visual acuity at last follow-up. CONCLUSIONS: Repeated swabbing effectively can eradicate corneal epithelial microsporidial lesions in approximately 1 week. It is easy to perform, less painful, and more acceptable for the patients.

Corneal status in primary angle-closure glaucoma with a history of acute attack.

PURPOSE: The corneal status of patients with primary angle-closure glaucoma (PACG) with a history of acute attack was investigated. METHODS: This cross-sectional study included 40 eyes of PACG patients with an earlier documented symptomatic acute angle-closure attack (aPACG), 40 uninvolved fellow eyes of aPACG patients (fPACG), 44 eyes of chronic PACG patients without such a history (cPACG), and 50 eyes of age-matched normal participants. All glaucoma patients had patent peripheral iridotomies with adequate intraocular pressure control. The examinations and recorded parameters included visual acuity, intraocular pressure, gonioscopy, vertical cup-to-disc ratio, specular microscopy, central corneal pachymetry, refraction, corneal curvature radius, anterior chamber depth, axial length, and lens thickness measurements, and the presenting intraocular pressure and the duration of acute angle-closure attack for aPACG eyes. RESULTS: The mean endothelial cell density was 2271±80 cells/mm(2) in aPACG, 2458±79 cells/mm(2) in fPACG, 2379±50 cells/mm(2) in cPACG, and 2559±45 cells/mm(2) in controls. The aPACG eyes had significantly lower endothelial cell density compared with normal eyes (P=0.002). There was no significant difference in endothelial cell density of aPACG eyes compared with fPACG or cPACG eyes. Multivariate analysis showed the duration of the acute attack was the only factor independently associated with corneal endothelial density of aPACG eyes. The mean central corneal thickness of aPACG (549±32 µm) did not differ significantly from control eyes (552±27 µm), cPACG (557±32 µm), and fPACG (553±31 µm) (P=0.911, 0.274, and 0.725, respectively). Corneal curvature radius of aPACG eyes was not significantly different from that of the comparison groups (all P>0.05). CONCLUSIONS: Corneal endothelial cell density was significantly reduced in aPACG eyes compared with normal eyes. No significant difference in endothelial cell density of aPACG eyes was noted when compared with fPACG or cPACG eyes. Corneal endothelial cell density was negatively associated with the duration of the acute attack, but was not associated with demographic and biometric characteristics. Central corneal thickness and corneal curvature radius were not associated with an earlier acute angle-closure attack.

Microsporidial keratitis in patients with hot springs exposure.

This retrospective study included 10 eyes of 9 patients diagnosed with microsporidial keratitis. All of them were known to contract this disease after taking baths in hot springs. The disease was diagnosed based on detecting microsporidia in corneal scrapings using Gram stain and the modified Kinyoun's acid-fast stain. The specimens from the last six patients were subjected to PCR and then sequencing. All of them revealed that the microorganism identified has a high similarity to Vittaforma corneae. Repeated debridement of the epithelial lesions successfully eradicated the microsporidial infection in all nine patients.

Combination photodynamic therapy and intravitreal bevacizumab used to treat circumscribed choroidal hemangioma.

Circumscribed choroidal hemagioma (CCH) is an ocular tumor that can result in decreased vision or blindness. Numerous treatment methods have been reported without satisfying results. In recent years, photodynamic therapy (PDT) with verteporfin has been used to treat choroidal hemagioma and resolve the associated exudative retinal detachment, and the results have been inspiring. Here, we report the case of a 36-year-old man with longstanding CCH who suffered from blurred vision for 3 years. He underwent PDT with intravenous infusions of verteporfin, which was a treatment method based on a modified version of the standard macular degeneration PDT protocol, in addition to subsequent intravitreal administrations of bevacizumab as adjuvant therapy for macular edema. Twelve months after treatment, the CCH tumor remained noticeably shrunken, with the complete absorption of the subretinal fluid and the absence of macular edema. In terms of treating subretinal fluid retention, this combination treatment is a safe, effective, and long-lasting therapy for treating established CCH tumors. However, even though the patient's visual field defects improved, the patient's visual acuity remained stable at 6/60 without further improvement. Long-term CCH with prolonged macular edema might have affected the visual prognosis. Patients with CCH still require long-term follow-up examinations after receiving PDT treatments.

Increased response to oxidative stress challenge in Graves' ophthalmopathy orbital fibroblasts.

PURPOSE: To investigate whether orbital fibroblasts from patients with Graves' ophthalmopathy (GO) are more responsive to oxidative stress. METHODS: Lipid peroxidation, oxidative DNA damage, reactive oxygen species (ROS) contents and activities of antioxidant enzymes were measured in cultured orbital fibroblasts from GO patients and age-matched normal controls in response to 200 µM hydrogen peroxide (H(2)O(2)). RESULTS: GO fibroblasts had increased basal levels of malondialdehyde (MDA), 8-hydroxy 2'-deoxyguanosine, superoxide anions, H(2)O(2), and manganese-dependent superoxide dismutase (Mn-SOD) activity, as well as decreased glutathione peroxidase (GPx) activity and the ratio between reduced (GSH) and oxidized glutathione (GSSG) compared with the orbital fibroblasts from normal subjects. After treatment of the cells with 200 µM H(2)O(2), the amplitude of increase in the intracellular levels of MDA (63% versus 26%), H(2)O(2) (24% versus 13%) and Mn-SOD activity (48% versus 23%) was exaggerated in GO fibroblasts compared with normal controls, respectively. In addition, treatment of GO fibroblasts with 200 µM H(2)O(2) led to a dramatic reduction of catalase activity (-59% versus -29%), GPx activity (-56% versus -13%), and GSH/GSSG ratio (-49% versus -21%), respectively. CONCLUSIONS: Elevated ROS and redox imbalance in GO orbital fibroblasts were exacerbated by H(2)O(2) as a result of exhaustion of GSH and compromise of antioxidant enzymes. Hypersensitivity to oxidative stress of GO orbital fibroblasts may play a role in the pathogenesis of GO.

Management of double-penetrating ocular injury with retained intraorbital metallic foreign body.

The prognosis of double penetrating ocular trauma is usually guarded. We report the good anatomical and functional outcome in a patient with double-penetrating ocular trauma associated with intraorbital foreign body. A 58-year-old man presented at the emergency room complaining of blurred vision of the left eye with stinging pain after he hammered an iron plate. Best-corrected visual acuity was hand movement/30 cm. Subconjunctival hemorrhage with one 1.4-mm laceration wound was noted over the nasal conjunctiva. Fundus examination showed vitreous hemorrhage with one whitish patch over the nasal retina. Orbital computed tomography scan revealed one metallic foreign body at the posterior nasal upper orbit. Double-penetrating globe injury with intraorbital foreign body was impressed, and immediate vitrectomy surgery with endolaser photocoagulation was carried out. One exit wound nasal to the disc was noted during operation. The intraorbital metallic foreign body was left alone. Vision recovered to 6/8.6 without ocular complication after a 20-month follow-up. Prompt, careful preoperative evaluation and meticulous vitrectomy intervention are essential in the successful management of such patients. Posteriorly located intraorbital metallic foreign body should be managed conservatively. Long-term regular electroretinography evaluation is needed for possible retinal toxicity from intraorbital foreign body.